Prospective Study on Factors Associated with Referral of Patients with Opioid Maintenance Therapy from Specialized Addictive Disorders Centers to Primary Care

International audienceBackground: One of the most important issues for opiate maintenance therapy efficacy is the involvement of primary care physicians (PCPs) in opiate use disorder treatment, especially after referral from specialized units. This study aimed to analyze the progress of subjects in a specialized center and after referral to PCPs. Methods: This study was an observational prospective study. Recruitment took place in a specialized addictive disorder center in western France. All patients were evaluated (sociodemographical data, severity of substance use disorders through the TMSP scale, the quality of life through the TEAQV scale) by physicians during the 5-year-follow up of the study. Analysis focused on four main times during follow-up: entry/last visit into specialized care and into primary care. Results: 113 patients were included in this study; 93% were receiving methadone and 7% buprenorphine. Ninety (90) were referred to primary care. In primary care follow-up, the probability of the lowest severity score for substance use disorders remained stable over time. Conclusions: In daily practice, a center specialized in addictive disorders referred OMT management to PCPs for a majority of patients, and benefits regarding substance use disorders severity and quality of life remained stable after referral. Our results need to be confirmed

Discussion des articles 6, 7 et 8 sur les apanages, lors de la séance du 13 août 1790

André Antoine Balthazar d', Ambly Claude Jean, marquis d', abbé Maury, Custine de Sarëck Adam Philippe, comte de, Enjubault de la Roche René Urbain, Latouche-Tréville, Camus Armand Gaston. Discussion des articles 6, 7 et 8 sur les apanages, lors de la séance du 13 août 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XVIII - Du 12 aout au 15 septembre 1790. Paris : Librairie Administrative P. Dupont, 1884. p. 46

How do people who use drugs receiving Opioid Medication Therapy perceive their treatment ? A multicentre study

International audienceAbstract Background The resurgence of heroin use and the misuse of pharmaceutical opioids are some of the reasons for a worldwide increase in opioid dependence. Opioid Medication Therapies (OMT) have amply demonstrated their efficacy. From a medical point of view, the main objectives of OMT concern medical and social outcomes, centred on risk reduction and the cessation of opioid use. But patient points of view can differ and few studies have explored opioid-dependent patient viewpoints on their OMT. This variable seems important to consider in a patient-centred approach. The aim of our study was to explore points of view of people who use drugs (PWUD) treated with OMT, in a large multicentre sample. Method A cross-sectional multicentre study explored the points of view of PWUD with Opioid Use Disorder following OMT. Data regarding the patients’ points of view were collected using a self-administered questionnaire developed by the scientific committee of the study. A descriptive analysis and an exploratory factor analysis were performed to explore the structure of items exploring patient viewpoints. Results 263 opioid dependent PWUD were included, a majority were men consuming heroin prior to being prescribed OMT. 68% were on methadone, 32% were on buprenorphine. Most PWUD identified a positive impact on their lives, with 92.8% agreeing or strongly agreeing that OMT had changed a lot of things in their lives. The exploratory factor analysis identified three factors: (F1) items related to points of views concerning the objectives and efficacy of OMT; (F2) items related to the legitimacy of OMT as a treatment compared to a drug, (F3) items related to experiences and relationships with OMT. Conclusion Patient viewpoints on efficacy were correlated with the pharmacological benefits of OMT and with the associated psychosocial measures. The implications of OMT in relationships, such as the feeling of being judged, concerned a majority. Points of view were ambivalent concerning the role of OMT as a treatment or as a drug. Involving patient points of view in therapeutic strategies decisions could help enhance positive views among PWUD on OMT and help PWUD towards their recovery. Trial registration: OPAL study was registered: (NCT01847729)

Suite de la discussion du projet de décret sur les apanages, lors de la séance du 21 décembre 1790

Dubois-Crancé Edmond Louis, Montmorency-Laval Mathieu Jean Félicité, duc de, Vernier Théodore, Enjubault de la Roche René Urbain, Bengy de Puyvallée Philippe Jacques de, Latouche-Tréville, Camus Armand Gaston, Chasset Charles Antoine, Lanjuinais Jean Denis. Suite de la discussion du projet de décret sur les apanages, lors de la séance du 21 décembre 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XXI - Du 26 novembre 1790 au 2 janvier 1791. Paris : Librairie Administrative P. Dupont, 1885. pp. 609-610